Imaging of Ventilation with Dual-Energy CT during Breath Hold after Single Vital-Capacity Inspiration of Stable Xenon

Honda, N.; Osada, Hiroyuki; Watanabe, Wataru; Nakayama, Mitsuo; Nishimura, Keiichiro; Krauß, Bernhard; Otani, Katharina

doi:10.1148/radiol.11110569

Cited by 53 publications

(37 citation statements)

References 16 publications

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“…More recently, Xe-DECT with a single-breath-hold technique could also depict pulmonary ventilation [13]. This Xe-DECT imaging technique appears to be safe without serious side effects in both children and adults since a xenon concentration of 35% is the approved maximum for clinical use.…”

Section: Discussionmentioning

confidence: 99%

“…This Xe-DECT imaging technique appears to be safe without serious side effects in both children and adults since a xenon concentration of 35% is the approved maximum for clinical use. In the volunteers with normal lungs, xenon was distributed homogeneously throughout the entire lung [3, 13]. In asthmatics setting, the ventilation defects seen on Xe-DECT showed significant correlations with the airflow obstruction on pulmonary function tests (PFTs) and the airway wall thickening on chest CT [4].…”

Section: Discussionmentioning

confidence: 99%

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Xenon-Enhanced Dual-Energy CT Imaging in Combined Pulmonary Fibrosis and Emphysema

et al. 2017

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BackgroundLittle has been reported on the feasibility of xenon-enhanced dual-energy computed tomography (Xe-DECT) in the visual and quantitative analysis of combined pulmonary fibrosis and emphysema (CPFE).ObjectivesWe compared CPFE with idiopathic pulmonary fibrosis (IPF) and chronic obstructive pulmonary disease (COPD), as well as correlation with parameters of pulmonary function tests (PFTs).MethodsStudied in 3 groups were 25 patients with CPFE, 25 with IPF without emphysema (IPF alone), 30 with COPD. Xe-DECT of the patients’ entire thorax was taken from apex to base after a patient’s single deep inspiration of 35% stable nonradioactive xenon. The differences in several parameters of PFTs and percentage of areas enhanced by xenon between 3 groups were compared and analyzed retrospectively.ResultsThe percentage of areas enhanced by xenon in both lungs were calculated as CPFE/IPF alone/COPD = 72.2 ± 15.1% / 82.2 ± 14.7% /45.2 ± 23.2%, respectively. In the entire patients, the percentage of areas enhanced by xenon showed significantly a positive correlation with FEV1/FVC (R = 0.558, P < 0.0001) and %FEV1, (R = 0.528, P < 0.0001) and a negative correlation with %RV (R = -0.594, P < 0.0001) and RV/TLC (R = -0.579, P < 0.0001). The percentage of areas enhanced by xenon in patients with CPFE showed significantly a negative correlation with RV/TLC (R = -0.529, P = 0.007). Xenon enhancement of CPFE indicated 3 different patterns such as upper predominant, diffuse, and multifocal defect. The percentage of areas enhanced by xenon in upper predominant defect pattern was significantly higher than that in diffuse defect and multifocal defect pattern among these 3 different patterns in CPFE.ConclusionThe percentage of areas enhanced by xenon demonstrated strong correlations with obstructive ventilation impairment. Therefore, we conclude that Xe-DECT may be useful for distinguishing emphysema lesion from fibrotic lesion in CPFE.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Xenon-Enhanced Dual-Energy CT Imaging in Combined Pulmonary Fibrosis and Emphysema

et al. 2017

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“…The latter can be challenging in the presence of arrhythmias or heart-rate variations during stress. Moreover, end-systolic (ES) imaging has recently been shown to provide improved visualization of subendocardial defects [1]. We developed an innovative ungated FPP technique capable of simultaneously eliminating DRAs [2,3] and enabling reconstruction of all slices at ES.…”

Section: Introductionmentioning

confidence: 99%

Dark-rim-free ungated first-pass perfusion CMR with 3-Slice end-systolic imaging: initial experience

Sharif

Arsanjani

Shaleṿ

et al. 2014

Journal of Cardiovascular Magnetic Resonance

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“…Dual-energy CT pulmonary angiography can simultaneously provide lung perfusion and pulmonary vessel mapping, affording more options for comprehensive lung imaging, and ordinarily does not expose patients to any significant additional radiation over that of standard CT pulmonary angiography techniques. 1 Previously, many studies have demonstrated the clinical value of dual energy CT perfusion and ventilation imaging, [1][2][3][4] for example, iodinated contrast-enhanced dual-energy CT has been used to investigate the iodine distribution in the lungs, improving the detection of pulmonary embolism, 1,2 whereas xenon-enhanced dual-energy CT has been used to map the xenon distribution in the lungs, which is helpful to visualize ventilation status in patients with emphysema and asthma and to assess the collateral ventilation of bronchus atresia in a static or dynamic scan. 3,4 Both xenon-enhanced dual-energy CT and iodinated contrastenhanced dual-energy CT can be simultaneously performed to show both regional lung ventilation and perfusion function.…”

mentioning

confidence: 99%

“…1 Previously, many studies have demonstrated the clinical value of dual energy CT perfusion and ventilation imaging, [1][2][3][4] for example, iodinated contrast-enhanced dual-energy CT has been used to investigate the iodine distribution in the lungs, improving the detection of pulmonary embolism, 1,2 whereas xenon-enhanced dual-energy CT has been used to map the xenon distribution in the lungs, which is helpful to visualize ventilation status in patients with emphysema and asthma and to assess the collateral ventilation of bronchus atresia in a static or dynamic scan. 3,4 Both xenon-enhanced dual-energy CT and iodinated contrastenhanced dual-energy CT can be simultaneously performed to show both regional lung ventilation and perfusion function. 5 This case is the first report to demonstrate the feasibility of perfusion/ventilation mismatch in 1 patient with pulmonary embolism visualized on CT, to the best of our knowledge.…”

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confidence: 99%

Dual Energy Computed Tomography Demonstrated Lung Ventilation/Perfusion Mismatch in a 19-Year–Old Patient With Pulmonary Embolism

Zhang

Zhou

2012

Circulation

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A 19-year-old woman was transferred into our hospital because of left lower extremity swelling for 4 years, anasarca for 2 months, and abnormal urine tests for 3 weeks. The patient had sudden symptoms of cough and hemoptysis 4 years ago, and her chest plain film showed abnormal bilateral lung opacities. Tuberculosis was suspected, although no definitive tubercle bacilli was found. The patient had left lower extremity swelling and left chest pain 2 weeks after antituberculosis therapy. The above-mentioned symptoms resolved after anticoagulant therapy. One year ago, the patient began to present decreased platelet amount and mild anemia. Two months ago, the patient had left low extremity swelling aggravated and abnormal urine tests, including urine protein (ϩϩϩϩ) and occult blood (ϩϩ). Routine blood test showed white blood cell of 3.3ϫ10 9 /L, hemoglobin of 85 g/L, platelet of 86ϫ10 9 /L. Blood biochemical tests showed albumin of 14.4 g/L, creatine level of 0.64 mg/dL, decreased C3 and C4 level, positive antinuclear antibody, and antidouble strand antinuclear antibody. Based on the clinical and laboratory findings, systemic lupus erythematosus was suspected and methylprednisolone plus therapy was initiated.Routine D-dimer test was positive (0.67 mg/dL). Thus, screening of venous thromboembolism was initiated. Lowextremity compressed ultrasonography was performed and venous thrombus in the left common femoral vein was found. Then, the patient was recommended to screen pulmonary embolism and renal vein thrombosis. Renal computed tomography (CT) venography was performed in a dual-source CT scanner (Somatom Deinition, Siemens Medical System) and showed that bilateral renal vein and inferior vena cava were negative. Dual energy CT ventilation and perfusion imaging in the dual-source CT scanner (Somatom Deinition, Siemens Medical System) were performed. Xenon-enhanced dual-energy CT ventilation imaging showed normal xenon distribution (Figure 1) in both lungs 80 seconds after inhaling the mix gas with 30% xenon 70% oxygen. Five minutes after xenon-enhanced dual-energy CT scan, iodinated contrast-enhanced dualenergy CT perfusion imaging was performed and showed left pulmonary artery occlusion (Figure 2) at CT pulmonary angiography from average weighted virtual 120-kVp images and corresponding perfusion defect in the whole left lung (Figure 3) at iodine maps. Ventilation/perfusion mismatch, a typical finding of pulmonary embolism in ventilation/perfusion scintigraphy, was clearly visualized at dual-energy CT perfusion and ventilation images (Figures 1 through 3). The patient did not undergo kidney biopsy because of venous thromboembolism events. She received anticoagulant therapy with low-molecular-weight heparin injected subcutaneously 2 times a day for 1 week. The patient was discharged after her symptoms resolved.The introduction of recent CT scanner generations enables dual-energy CT applications in routine practice. Dual-energy CT pulmonary angiography can simultaneously provide lung perfusion and pulmonary vessel map...

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Imaging of Ventilation with Dual-Energy CT during Breath Hold after Single Vital-Capacity Inspiration of Stable Xenon

Abstract: Xenon-enhanced dual-energy CT with the single-breath-hold technique could depict ventilation in phantoms and in four volunteers.

Cited by 53 publications

References 16 publications

Xenon-Enhanced Dual-Energy CT Imaging in Combined Pulmonary Fibrosis and Emphysema

Xenon-Enhanced Dual-Energy CT Imaging in Combined Pulmonary Fibrosis and Emphysema

Dark-rim-free ungated first-pass perfusion CMR with 3-Slice end-systolic imaging: initial experience

Dual Energy Computed Tomography Demonstrated Lung Ventilation/Perfusion Mismatch in a 19-Year–Old Patient With Pulmonary Embolism

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